Public Hospital Emergency Departments Struggle With Severe Delays Despite Staffing Promises

3rd November 2024 – (Hong Kong) As Hong Kong continues to contend with emergency department waiting times exceeding seven hours at facilities like Tuen Mun Hospital, the city’s healthcare system faces increasing pressure to reform its approach to urgent care delivery. The harsh reality of patients enduring lengthy waits, especially during holiday periods when private clinics are closed, emphasizes the need for systemic change that goes beyond simple fee adjustments or capacity increases.

The recent case at Caritas Medical Centre this morning, where patients reportedly waited over seven hours despite only having 5-6 patients and two doctors on duty, exemplifies the structural inefficiencies plaguing the system. Such incidents raise serious questions about resource allocation and management in Hong Kong’s public healthcare system, particularly during off-peak hours when private alternatives are limited.

Looking to the U.K.’s National Health Service (NHS) provides valuable insights into potential solutions. The NHS’s integrated care system (ICS) approach, which coordinates services across different healthcare settings, offers a blueprint for reform. This model has proven particularly effective in facilities like Northumbria Healthcare, which consistently achieves superior A&E performance through seamless integration of hospital and community services.

Compared to Hong Kong’s current fragmented healthcare model, the United Kingdom’s National Health Service (NHS) exemplifies how an integrated care system can significantly alleviate congestion in emergency departments. This improvement is largely due to the coordinated efforts involving primary care, emergency services, and community healthcare providers, which collectively enhance the efficiency of the patient care journey.

In Hong Kong, the situation is quite dire, as revealed by data from the Hospital Authority covering its 18 public hospitals, including Kwong Wah Hospital, Queen Elizabeth Hospital, and North District Hospital. Here, patients with non-urgent conditions often endure waiting times that can exceed five hours. This is a symptom of broader systemic issues, including limited after-hours care, with private clinics closing by 10pm. This closure forces those needing non-emergency care to visit A&E departments, adding unnecessary strain. The lack of 24-hour community healthcare facilities and insufficient evening services at general outpatient clinics further exacerbate the problem. Additionally, the distribution of medical personnel, particularly during night shifts, is less than optimal. For instance, at Caritas Medical Centre, even a low patient count results in lengthy delays due to systemic inefficiencies, and the concentration of resources in major hospitals leaves smaller facilities struggling to maintain service standards.

Drawing inspiration from the NHS could be beneficial for Hong Kong. The establishment of Same Day Emergency Care Centres adjacent to A&E departments could handle non-critical cases more efficiently, implementing rapid assessment protocols and creating clear pathways for specialised but non-emergency care. The introduction of virtual ward systems could allow for remote monitoring of stable patients and make use of telemedicine for follow-up care. Moreover, strengthening the integration between public hospitals, private providers, and expanding general outpatient services into evenings and weekends would help in managing the load on emergency services more effectively.

Financial restructuring is also crucial. The current A&E fee of HK$180 for eligible persons while affordable, does not address the root of the issue. A differential pricing model based on the actual services provided could be more effective. Furthermore, investing in community health and preventive care, alongside creating incentives for private sector participation in after-hours care, could alleviate some of the systemic pressures.

Integrating modern technology through digital triage systems, real-time waiting updates, and mobile applications for scheduling and virtual consultations could significantly improve service delivery and patient satisfaction. Additionally, there should be a focus on workforce development, enhancing training for emergency department staff, better distributing medical personnel, and creating specialised roles for handling non-emergency cases.

The NHS has shown that effective integration of services can lead to significant improvements, as seen in Northumbria’s seamless care transitions, Manchester’s urgent care village, and Birmingham’s use of digital technology to streamline patient flow. Implementing similar strategies in Hong Kong could begin with immediate expansions of evening clinic services, introduction of mobile medical teams during peak times, and improved triage protocols. Over the medium term, establishing urgent care centres in high-demand areas, developing integrated IT systems, and forming community health networks would be beneficial.

Over the long term, a complete integration of public and private healthcare services, the development of comprehensive preventive care programs, and sustainable healthcare workforce planning will be essential. Success should be measured by reduced waiting times, improved patient satisfaction, better resource utilization, and fewer unnecessary A&E visits. This would involve substantial community engagement through public education on the appropriate use of emergency services and involving the community in healthcare planning.

Economically, an integrated approach could reduce healthcare costs, improve workforce productivity, and enhance public health outcomes. As Hong Kong’s population ages and the burden of chronic diseases grows, the healthcare system must evolve to meet these challenges.

Transforming Hong Kong’s emergency care services into an integrated model will demand robust commitment, ongoing investment, and a cultural shift towards preventive and community-based care. Although this will require substantial initial funding, it offers the most sustainable solution to the persistent crisis in A&E waiting times. The success of these reforms will hinge on a dedication to long-term systemic change rather than temporary fixes, ensuring a responsive and efficient emergency care system for all residents.

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